本文關(guān)鍵詞： 肺減容術(shù) 慢性阻塞性肺疾病 胸腔鏡 meta分析 隨機對照試驗　出處：《上海交通大學(xué)學(xué)報(醫(yī)學(xué)版)》2017年07期 　論文類型：期刊論文

【摘要】：目的·應(yīng)用meta分析比較電視輔助胸腔鏡(VATS)肺減容術(shù)與常規(guī)切口肺減容術(shù)治療重度慢性阻塞性肺疾病患者的效果。方法·計算機檢索Web of Science、EMbase、PubMed、the Cochrane Library、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻數(shù)據(jù)光盤數(shù)據(jù)庫、萬方數(shù)據(jù)庫、維普數(shù)據(jù)庫等,收集關(guān)于VATS肺減容術(shù)(VATS組)與常規(guī)切口肺減容術(shù)(開胸組)治療重度慢性阻塞性肺疾病的隨機對照試驗及非隨機對照研究。文獻檢索時間均從建庫至2016年11月。評價納入文獻的質(zhì)量并提取資料。采用RevMan5.3統(tǒng)計軟件進行meta分析。結(jié)果·檢出相關(guān)文獻779篇,根據(jù)納入標(biāo)準(zhǔn)最終入選12篇,共966例患者。Meta分析結(jié)果顯示:在手術(shù)時間方面,VATS組中行雙側(cè)肺減容術(shù)的手術(shù)時間大于常規(guī)切口組,行單側(cè)肺減容術(shù)的手術(shù)時間與開胸組的差異無統(tǒng)計學(xué)意義。在胸管留置時間方面,VATS組中行雙側(cè)肺減容術(shù)的胸管留置時間與開胸組的差異無統(tǒng)計學(xué)意義,行單側(cè)肺減容術(shù)的胸管留置時間明顯少于開胸組。與開胸組比較,VATS組術(shù)中出血量及術(shù)后胸腔引流量顯著減少。在術(shù)后肺功能及血氣分析方面,VATS組的術(shù)后6min步行距離大于開胸組,2組在第一秒用力呼氣量、動脈血氧分壓及術(shù)后并發(fā)癥發(fā)生率方面的差異無統(tǒng)計學(xué)意義。結(jié)論·相比于常規(guī)切口肺減容術(shù),VATS肺減容術(shù)是更好的選擇。因研究質(zhì)量和研究樣本的局限性,該結(jié)論仍有待設(shè)計嚴(yán)謹(jǐn)?shù)拇髽颖倦S機對照試驗加以驗證。
[Abstract]:Objective: to compare VATS with video-assisted thoracoscopy by meta analysis. Effect of lung volume reduction and conventional incision lung volume reduction on patients with severe chronic obstructive pulmonary disease. Methods Web of Science was searched by computer. Cochrane Library, full text Database of Chinese academic Journals, CD-ROM Database of Chinese Biomedical Literature data, Wanfang Database. Wiper, database, etc. Collect information on VATS lung volume reduction and conventional incision lung volume reduction (thoracotomy group). A randomized controlled trial and a non-randomized controlled trial for the treatment of severe chronic obstructive pulmonary disease. The retrieval time of the literature was from the establishment of the database to November 2016. The quality of the literature was evaluated and the data were extracted by RevMa. Meta analysis was carried out with statistical software N5.3. Results 779 papers were found. A total of 966 patients. Meta-analysis showed that bilateral lung volume reduction in vats group was longer than that in conventional incision group. There was no significant difference between the operation time of unilateral lung volume reduction and that of thoracotomy group. There was no significant difference between bilateral lung volume reduction group and thoracotomy group in the time of chest tube indwelling. Compared with the thoracotomy group, the volume of intraoperative bleeding and postoperative thoracic drainage volume in vats group were significantly reduced, and the postoperative lung function and blood gas analysis. The walking distance 6 minutes after operation in VATS group was longer than that in open chest group and forced expiratory volume at 1 second in group 2. There was no significant difference in arterial partial pressure of oxygen and incidence of postoperative complications. Conclusion: compared with conventional incision lung volume reduction. VATS lung volume reduction is a better choice. Due to the quality of the study and the limitations of the study samples, this conclusion has yet to be verified by a well-designed randomized controlled trial of large samples.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬蘇州九龍醫(yī)院胸外科;上海交通大學(xué)醫(yī)學(xué)院附屬蘇州九龍醫(yī)院重癥醫(yī)學(xué)科;
【分類號】：R655.3
【正文快照】： 慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一種以不可逆性氣流受限為主要特征的進行性、慢性氣道炎性疾病[1],是未來危害人類健康的主要疾病[2]。當(dāng)COPD發(fā)展到中重度后,單純藥物治療效果不理想[3]。美國肺氣腫治療試驗(National Emphysema Treatment T

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